It should be noted that the plague still remains endemic in Madagascar, especially in the central highlands. A seasonal upsurge, predominantly of the bubonic form, typically occurs yearly between September and April. Any UN personnel residing in or traveling to Madagascar should continue to take precautions as more plague cases are expected to be reported until April 2018.

Advice for UN Personnel Residing in/Travelling to Madagascar

In order to reduce the risk of UN personnel and their dependents from contracting plague in Madagascar, the United Nations Medical Directors (UNMD) have developed specific recommendations (English/French) for UN personnel deploying to or residing in the country.

Plague is an animal disease that can spread to humans – caused by Yersinia pestis bacteria. It is transmitted to humans through the bite of infected fleas that live among rodents such as squirrels, chipmunks, woodrats, prairie dogs, rabbits, and mice.

How do people become infected with plague?

People most commonly acquire plague when they are bitten by a flea that is infected with the plague bacteria. People can also become infected from direct contact with infected tissues or fluids while handling an animal that is sick with or that has died from plague. Finally, people can become infected from inhaling respiratory droplets after close contact with cats and humans with pneumonic plague.

What are the different forms of plague?

There are three forms of plague:

· Bubonic plague: Patients develop sudden onset of fever, headache, chills, and weakness and one or more swollen, tender and painful lymph nodes (called buboes). This form is usually the result of an infected flea bite. The bacteria multiply in the lymph node closest to where the bacteria entered the human body. If the patient is not treated with appropriate antibiotics, the bacteria can spread to other parts of the body.

· Septicemic plague: Patients develop fever, chills, extreme weakness, abdominal pain, shock, and possibly bleeding into the skin and other organs. Skin and other tissues may turn black and die, especially on fingers, toes, and the nose. Septicemic plague can occur as the first symptoms of plague, or may develop from untreated bubonic plague. This form results from bites of infected fleas or from handling an infected animal.

· Pneumonic plague: Patients develop fever, headache, weakness, and a rapidly developing pneumonia with shortness of breath, chest pain, cough, and sometimes bloody or watery mucous. Pneumonic plague may develop from inhaling infectious droplets or from untreated bubonic or septicemic plague that spreads to the lungs. The pneumonia may cause respiratory failure and shock. Pneumonic plague is the most serious form of the disease and is the only form of plague that can be spread from person to person (by infectious droplets).

There is currently no commercially available vaccine or preventive medication against plague. However, antibiotic treatment is effective against the plague bacteria, so early diagnosis and early treatment can save lives.

Could one person get plague from another person?

Yes, when a person has plague pneumonia they may cough droplets containing the plague bacteria into air. If these bacteria-containing droplets are breathed in by another person they can cause pneumonic plague. Human-to-human transmission is rare and typically requires direct and close contact with the person with pneumonic plague.

What is the risk for UN personnel?

The risk of infection with Yersinia pestis for international travellers to Madagascar is generally low. However, UN personnel travelling to rural areas of plague-endemic regions may be at risk, particularly if camping or hunting or if contact with rodents takes place.